The First Case of Vancomycin Induced Neurotoxicity and Literature Review

Abstract

A 53-year-old female patient was admitted to the hospital due to “occasional lower back pain, burning pain in urination, and bilateral kidney stones for 4 months”. After admission, she was diagnosed with urinary tract infection based on urine routine examination and received anti infection treatment with ceftazidime 2g Q12H. The patient’s burning pain in urination and urine routine examination improved compared to before. Reexamination of urine culture showed that multidrug resistant Enterococcus faecium (vancomycin sensitive), so vancomycin 1g Q12H was added. The patient complained of double eyelid swelling, scalp itching, both legs weakness and pain after each infusion of vancomycin. After stopping the drug, the patient slightly improved. After another infusion, the above discomfort occurred again. Therefore, the clinician asked the Pharmaceutical Department for consultation. The clinical pharmacist considered that the above discomfort was vancomycin-related adverse reactions. Considering that the symptoms of urinary tract infection and urine routine were significantly improved, clinical pharmacists recommended to discontinue vancomycin. After discontinuation of vancomycin, the patient’s double eyelid swelling, scalp itching, legs fatigue and pain gradually subsided. On the 14th day after admission, the patient was discharged after there were no significant abnormalities in urine routine.

Vancomycin is a narrow-spectrum antibiotic of glycopeptides. It exerts a rapid bactericidal effect by inhibiting the synthesis of glycopeptides in bacterial cell walls. It can also change the permeability of bacterial cell walls and selectively inhibit RNA biosynthesis. Its oral absorption is poor, mainly for intravenous administration. Its main adverse reactions were hypotension, phlebitis, nephrotoxicity, ototoxicity, hypersensitivity, red man syndrome, neutropenia, chills, fever and interstitial nephritis. Other cases reported adverse reactions such as liver damage, bone marrow suppression, shortness of breath, limb tremor, Kounis syndrome, etc.

This study reported a case of double eyelid swelling, scalp itching, legs weakness and pain and prolonged hospitalization after the use of vancomycin due to urinary system infection, in order to reduce and prevent such adverse reactions. No adverse reactions similar to this case have been reported yet.